Extended wear cervical collar

ABSTRACT

A cervical collar is disclosed which is formed from a stiff flexible plastic material and comprises (a) a neck encircling band comprising a back portion and a front portion and (b) a chin support formed from such plastic material. The collar provides two features which confer greater comfort when the collar is worn for extended periods of time. The chin support is supported to reduce the force of contact between the chin support and the top edge of the front portion of said collar. In a preferred embodiment, the support is provided by a plurality of load-bearing tabs extending from the top edge of the front portion of the collar. The collar also has a shelf-forming member which is attached to the back portion of the collar. Preferably the shelf-forming member is a sheet of padding material and the forming means is a strap which passes between the back portion of the collar and the shelf-forming member such that when the strap is engaged to hold the back portion in a flexed position the shelf-forming member forms the supporting shelf.

This is a continuation of application Ser. No. 07/623,853, filed Dec. 7,1990 now U.S. Pat. No. 5,097,824.

FIELD OF THE INVENTION

The present invention relates generally to cervical collars, moreparticularly to cervical collars which provide cervical support whileallowing comfortable extended wear.

BACKGROUND OF THE INVENTION

Recently many cervical collars have been marketed which are constructedfrom stiff, flexible plastic materials. These designs provide cervicalsupport without the metal structure and bulk associated with priorcollars. Thus, the collars are more portable, easily stored andrelatively easy to use compared to more traditional devices. Thesecollars include those disclosed in U.S. Reissue Pat. No. 32,219 and U.S.Pat. No. 4,712,540 and collars sold on the market by Jerome Medical, Mt.Laurel, N.J., under the trade name "NecLoc".

Applicants are inventors of the "STIFNECK"™ collar disclosed as thepreferred embodiment in U.S. Reissue Pat. No. 32,219 (the disclosure ofwhich is incorporated herein by reference as if fully set forth) whichhas become an industry leader. Although the STIFNECK collar providessuperior cervical support and is easy to use in an emergency situationwhere strict immobilization is the key and patient comfort is not aprimary concern, it has only limited use as an extended wear collar(i.e., a collar for patient wear over a treatment period, usually daysor weeks) where immobilization concerns are much less strict and patientcomfort is of much greater concern. This is also true for the collar ofU.S. Pat. No. 4,712,540 and the NecLoc collar. It would, therefore, bedesirable to provide a cervical collar which provides the portabilityand convenience of these types of collars, while providing featureswhich confer greater patient comfort.

SUMMARY OF THE INVENTION

A cervical collar is disclosed which is formed from a stiff flexibleplastic material and comprises (a) a neck encircling band comprising aback portion and a front portion and (b) a chin support formed from suchplastic material. The collar provides two features which confer greatercomfort when the collar is worn for extended periods of time. The chinsupport is supported by loadbearing means which redistributes the forceof contact between the chin support and the top edge of the frontportion of the collar. In a preferred embodiment, the load bearing meansis a plurality of load-bearing tabs extending from the top edge of thefront portion of the collar. The collar also has a shelf-forming memberwhich is attached to the back portion of the collar. Forming means arealso attached to the back portion of the collar for holding the backportion in a flexed conformation and for forming an supporting shelffrom the shelf-forming member. Preferably the shelf-forming member is asheet of padding material and the forming means is a strap which passesbetween the back portion of the collar and the shelf-forming member suchthat when the strap is engaged to hold the back portion in a flexedposition the shelf-forming member forms the supporting shelf.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a perspective view of a preferred embodiment of the collar ofthe present invention.

FIGS. 2 and 3 are, respectively, front and back plan views of the frontportion of a preferred embodiment of the present invention.

FIG. 4 is a back plan view of the back portion of a preferred embodimentof the present invention.

FIGS. 5 and 6 are front plan views of the back portion of a preferredembodiment of the present invention. In FIG. 6, the padding shown inFIG. 5 has been removed to show the underlying structure of the depictedembodiment.

FIG. 7 depicts the application of a preferred embodiment of the presentinvention to a patient.

FIG. 8 depicts the application of an alternative embodiment of thepresent invention to a patient.

FIGS. 9 and 10 are top perspective views of two different conformationsof a preferred embodiment of the present invention.

FIGS. 11-14 depict a preferred embodiment of the present inventionapplied to a patient.

FIG. 15 is a perspective view of the back portion of an alternativeembodiment of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

FIGS. 1-7 and 9-14 depict a preferred embodiment collar incorporatingthe features of the present invention. Generally, in its assembledshape, collar 20 forms a circular or ovoid configuration for surroundingthe neck as shown in FIGS. 9 and 10. As shown in FIG. 1, a neckencircling band is formed from back portion 21 and front portion 22.

Back portion 21 has top 23 and bottom 24 edges which contact thewearer's body for lending support. Top edge 23 contacts the occipitalregion of the head and bottom edge 24 contacts the wearer's shoulderssuch that the head is for the most part prevented from tilting backward.A plurality of flaps 25 along edges 23 and 24 help to conform thoseedges to the shape of a specific wearer's head and shoulders. Backportion 21 is fitted with pad 26 which prevents edges 23 and 24 fromdirectly contacting the wearer, thus affording greater comfort. Backportion 21 optionally has a manifold 27 which facilitates airflowthrough the collar. Fastening straps 28 extend from back portion 21 andare made from hook and loop fastener material, such as Velcro®.

Back portion 21 is also fitted with means for adjusting the contour ofback portion 21 and pad 26. In the embodiment shown in FIGS. 4, 6 and 7,strap 41 is fitted with notches 42 which engage with slots in backportion 21 through which strap 41 extends to hold the back portion inits flexed conformation. In the embodiment shown in FIG. 8, hook andloop strap 29 extends through slots in back portion 21 such that theyare engageable with patches (not shown; attached to the surface of theback portion of the collar) which are made from hook and loop fastenermaterial which is the mate to strap 29. Either strap 29 or strap 41extends between pad 26 and back portion 21 as shown in the Figures. Useof strap 29 or 41 to adjust the contour of back portion 21 and pad 26 isfurther described below.

Front portion 22 has top 31 and bottom 32 edges. Bottom edge 32 conformsgenerally to the contour of the wearer's shoulders and clavicle. Flaps33 bend to facilitate conforming bottom edge 32 to such shape. Pad 34 isoptionally provided to make contact between the wearer and bottom edge32 more comfortable. Top edge 31 is generally curved to receive chinsupport 35 and forms loadbearing tabs 36, which support chin support 35.The interaction of chin support 35, load-bearing tabs 36 and the topedge 31 of front portion 22 are described further below. Contact betweenthe wearer's mandible and chin support 35 and the wearer'sshoulders/clavicle and the bottom edge 32 of front portion 22 preventsignificant tilting of the head forward. Fastening strips 40 (which arethe mates to fastening straps 28) are provided for attaching the frontand back portions of the collar as described below. Front portion 22 mayalso optionally have a tracheal orifice 45 which contributes to airflowthrough the collar and allows access to the trachea during use. Frontportion 22 may also optionally be fitted with a reinforcing member 37which lends increased rigidity and support.

In its unflexed conformation, chin support 35 is generally C-shaped. Inits flexed conformation, chin support 35 is generally U- or V-shapedsuch that it conforms to the shape of the lower edge of the wearer'smandible (i.e., along the jaw/chin line). The ends of chin support 35are attached to front portion 22 by fasteners 38 in the embodiment shownin the Figures. Other means for fastening the ends can be used. The endsof the chin support may be either attached to or detachable from theneck encircling band. Chin support 35 is optionally provided with pad 39for greater comfort.

In certain alternative embodiments, the neck encircling band is formedfrom a single panel (for example as shown in the Figures of U.S. ReissuePat. No. 32,219), wherein the single panel has back and front portionshaving features corresponding to those described herein for back portion21 and front portion 22. In such embodiments, only one fastening strapand fastening strip is required.

In other alternative embodiments, the neck encircling band is formedfrom a single panel which splits in the back in a manner similar to thatshown in the Figures of U.S. Pat. No. 3,530,853, wherein the singlepanel has back and front portions having features corresponding to thosedescribed for back portion 21 and front portion 22. In such embodiments,only one fastening strap and fastening strip is required.

The neck encircling band of collars of the present invention can be madefrom various stiff flexible plastics, including without limitation highand low density polyethylene, polyvinylchloride,acrylonitrile-butadiene-styrene copolymer, polypropylene, etc. Padding,straps and strips can be joined to the collar by any suitable fasteningmeans, including without limitation snap fasteners, staples andadhesive. Although hook and loop fastening material is used as thepreferred means to hold the collar in its neck encircling conformation,other means can be used to perform the same function, such as straps,buckles, snaps, fasteners, cords, tabbed strips or any othersubstantially nonstretch material with latching means.

The preferred embodiment is applied to a patient as shown in FIGS. 11and 12 as follows. Back 21 and front 22 portions and chin support 35 arepositioned with respect to the wearer's head, chin, neck and shoulders.Fastening straps 28 and fastening strips 40 are engaged to secure thecollar snugly around the neck in the neck encircling conformation suchthat flexion, extension and lateral movement of the cervical spine isrestrained to the desired degree.

With prior art collars, such as that shown in U.S. Reissue Pat. No.32,219 and U.S. Pat. No. 4,712,540, the wearer's chin bears a weightload to prevent the cervical spine from flexing (i.e., the head fromtilting forward). The majority of this load is borne along the lower andlingual (inside) edge of the mandible along the line where the chinsupport contacts the top edge of the front portion of the collar, suchas shown in certain figures of U.S. Reissue Pat. No. 32,219 and U.S.Pat. No. 4,712,540. While contact at this point is desirable forachieving strict immobilization of the spine, it can cause significantdiscomfort for the wearer, especially upon extended wear. Pressure fromthe weight load can cause pressure sores and accompanying tissue damage.Former collars also tend to concentrate a significant amount of the loadunderneath the patient's chin in the midline area.

Collars of the present invention provide greater wearer comfort by atleast partially alleviating this load bearing problem while maintainingthe desired degree of immobilization of the cervical spine. As shown inFIGS. 11 and 12, in accordance with the present invention, chin support35 is supported at least in part by load-bearing tabs 36 rather than bytop edge 31 alone. This allows the formation of points of support thatmove in response to an increased load on the chin support, which tendsto redistribute some of the weight load from the lingual surface of thejaw to the buccal (outside) edge of the mandible, resulting in lessstress at a single position. As more load is placed on the chin support,the tabs flex outwardly and the point of contact with the chin supportmoves toward the outer edge of the chin support (compare FIGS. 11 and12). The flexibility of tabs 36 also allows some movement of the jaw,such that the wearer can relieve discomfort felt in a given positionwithout losing a significant degree of immobilization. Although the loadredistribution achieved by the present invention may not completelyalleviate pressure sores and discomfort, such adverse effects aregreatly reduced by this feature. In addition, unless fully loaded suchthat the tabs have flexed to the point where the load is being carriedon the edge of the encircling band, little or no pressure is applied tothe underside of the patient's chin in the midline area whichsignificantly impacts patient comfort, especially while swallowing.

Collars of the present invention also provide greater wearer comfort byproviding an adjustable support for the lower occipital region of thewearer's head. In prior art collars, the back of the head is supportedand extension of the cervical spine is limited by contact between thebottom edge of the back portion of the collar and the wearer's shouldersand between the top edge of the back portion of the collar and a contactline on the back of the wearer's head as shown in U.S. Reissue Pat. No.32,219 and U.S. Pat. No. 4,712,540. Although such collars providesupport to the back of the head, such support is provided by contactalong a single line corresponding to the line of contact of the occiputwith the top edge of the collar. Collars of the present invention arefitted with means for adjusting the conformation of the back portion ofthe collar and its associated pad to form a shelf which provides supportover a greater portion of the lower occipital region, thus reducing themore localized pressure found in former collars.

In the preferred embodiment shown in FIGS. 7-10, after the collar isapplied as described above, the occiput supporting shelf is provided byflexing back portion 21 of the collar to increase its degree ofcurvature to conform to the patient's occiput. Strap 29 or 41 is thenpulled taut as shown in FIGS. 7 and 8 such that pad 26 is pulled awayfrom the inner surface of back portion 21 and supported in such positionby strap 29 or 41. The ends of strap 29 or 41 are then secured to holdthe collar in this configuration. In a alternative embodiment, pad 26could be eliminated such that the occiput supporting shelf is formed bystrap 29 or 41 alone. In alternative embodiments, the back portion ofthe collar and the shelf-forming pad can be conformed prior toapplication of the collar to the wearer.

As shown by comparison of FIGS. 11 and 13 with FIGS. 12 and 14,formation of the occiput supporting shelf supports the lower occipitalregion of the wearer's head, resulting in greater wearer comfort. Theshelf formed by this construction provides a greater point of contactwhich can bear some of the load presented by the patient's head (whichwould otherwise be carried by the posterior muscles of the neck).

FIG. 15 depicts an alternative construction which provides an occiputsupporting shelf in accordance with the present invention. In thisembodiment no pad is employed. Instead flexible member 46 provides thesupporting surface. Flexible member 46 is attached at one end to backportion 21. Its other end extends through slot 43 in back portion 21.Flexible member 46 is made of a stiff, flexible material such as thosematerials preferred for formation of the neck encircling band,cardboard, etc. Strap 41 operates in the manner previously described.When back portion 21 is flexed into the desired conformation surface 44contacts the patient's occiput. The angle of surface 44 can be adjustedby moving flexible member 46 into or out of slot 43 to achieve thedesired angle corresponding to the contour of patient's occiput.

Flexing back portion 21 in the manner described to form the occiputsupporting shelf also results in some redistribution of the load on thechin piece. As shown by comparison of FIGS. 9 and 10, as the backportion of the collar is flexed, the diameter of the collar from thepatient's left to right decreases. As a result, the chin support is alsoflexed such that its ends are closer together, resulting in a shift ofthe load toward the posterior portion of the mandible and a slightlifting of the chin from the chin support as shown by comparison ofFIGS. 11 and 12.

In alternative embodiments, other means could be used to provide anocciput supporting shelf. For example, although a pad is preferred, theshelf could be formed from other materials which can be conformed to thedesired shape, such as polyethylene, polyurethane, cardboard, paper,cloth, etc. Furthermore, means other than a strap o tabbed strip can beused to place the back portion of the collar in the proper conformationand to support the shelf-forming member (e.g., the pad), such as belts,cords, strings, etc.

The combined effects of load redistribution resulting from flexing theback portion of the collar and formation of the occiput supporting shelfand that provided by load-bearing construction supporting the chinsupport provide an especially favorable increase in wearer comfort.Embodiments employing both the occiput supporting shelf and load-bearingconstruction of the present invention provide upward balanced support ofthe head while moving the primary load-bearing points away from theunderside of the patient's chin at midline.

What is claimed is:
 1. A cervical collar comprising (a) a neckencircling band formed from a stiff flexible plastic material comprisinga back portion and a front portion, said front portion having asubstantially continuous top edge and (b) a chin support formed from astiff flexible plastic material, wherein said chin support is supportedabove said top edge by a plurality of load bearing means extendingupwardly from said front portion which shift the point of contactbetween said chin support and said front portion in response toincreased force on said chin support.
 2. The collar of claim 1 whereinsaid load bearing means are a plurality of load bearing tabs.
 3. Thecollar of claim 1 wherein said load bearing means are a plurality ofload bearing tabs extending from said top edge of said front portion.